HHE 446: Quiz 1

Red-lining

- Mark the low income socioeconomic population - Still happens til this day - Lower income schools - Less ability to actually buy a house

The Census Bureau projects that in the next 4 decades the nation will have:

- Most of the population concentrated in urban areas rather than rural - Immigration will continue to drive demographic shifts - The number of people 60+ will continue to increase (people are living longer) - Increasing number of US residents will speak a language other than english - Non-white population expected to become the majority hispanic/asian population will continue to grow

Reversal

- Occurs when people adopt the view that other cultures are superior to their own, to secure approval, acceptance or praise from minority groups - Reversal may masquerade as cultural awareness or competence, since it provides a positive experience of a different culture along with seemingly analytical criticisms of one's own culture - However, the positive experience of the other culture is at an unsophisticated stereotypical level, and the criticism of one's own

Retreat

- Occurs when people move from a higher ethnocentric stage to an lower stage - Most commonly seen from minimization to defense - Retreat functions as a threat response, when people are confronted with cultural difference or when they feel criticized or judged for their personal views

Why do you think that people who spend more time in self reflection tend to have more empathy for others? What is the connection happening there?

- Once you understand yourself it's easier to relate to others - You can't help someone else without understanding yourself

What is Bennett's Model?

- Originally developed by Milton Bennet in 1986, sociologist - Describes the standard ways in which people experience, interpret, and interact across cultural differences - provides a framework to explain how people experience and engage in cultural difference - By using concepts from psychology and communication theory, he organized these observations into positions along a continuum of increasing sensitivity to cultural difference

Social barriers

- Racism - Education level - Stigma, poverty, SES

Demographic shift

- The numbers and characteristics of the US population have been changing drastically ever since the turn of the century - The racial and ethnic diversification of the US population established the need to cultural and linguistic competence

Cultural is Dynamic

- Though the term "culture" is often used when describing different ethnic or religious affiliations, most people experience and participate in different cultures just by moving through their daily lives - Example) a person's family or home culture will likely have distinctly different qualities and behavioral expectations that their work culture, school culture, or social group culture - A person cannot begin to understand the makeup and contact of another person's life without being aware and reflective of their own background and situation first

Primary care doctors

Family doctors, general practitioners, surgeons

Ethnorelative Acceptance stage example

I accept but may not agree with other cultures. Generally, I am curious and respectful.

Ethnorelative Integration stage example

I easily move in and out of different cultural worldviews

Life Expectancy (health disparity)

how long someone is expected to live

ehtnorelativism

the experience of one's own and other cultures as "relative to context"

Ethnocentrisim

the experience of one's own culture as "central to reality"

What is health?

"Health is a state of complete physical, social and mental wellbeing, and not merely the absence of disease or infirmity." - WHO 1948

Cultural Humility is a Pathway to Empathy

"Not a discreet endpoint, but a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with participations, communities,k colleagues, and with themselves" - Leland Brown, 1994

Public health

"Public health is what we AS A SOCIETY. Do COLLECTIVELY to assure the conditions in which (all) people can be healthy" Institute of Medicine 1988

Ethnocentric Defense stage example

"We" are superior and "they" are inferior. One feels threatened and is highly critical. What is strange may be labeled as stupid.

Cultural Awareness

- "Me Centered" Analysis: What are my values, beliefs, and customs? - "Other Centered: Analysis: What are other's values, beliefs and customs? - It means being observant and consciousness of similarities and differences among and between cultural groups - Includes: Having a firm grasp of what culture is and what it is not, Understanding how people acquire their cultures, Being conscious of one's own culturally shaped values, beliefs, perceptions, and bias

Denial Stage Quotes

- "They were born here, so they should know how to do it the American way" - "As long as everyone speaks English, there should be no problem"

Minimization Stage Quotes

- "We try to treat everyone equally" - "I don't see color" - "I don't see any differences in race, gender, or culture. We are all just people"

How can we take this seemingly complex definition of health disparities and translate it into terms that you can explain to someone who maybe isn't a public health major?

- Barriers vs. advantages to health of a certain population - Concerns about social justices

Ethnocentric orientations

- Can be seen as ways of avoiding cultural difference, either by denying its existence, by raising defenses against it, or by minimizing its importance - negative connotation

What are the affects of enforcing diversity? (TedTalk)

- Creativity - Problem solving: people from different backgrounds bring their own opinions - Communication - Friendship

A community effort

- Health is truly a community effort - People have the power to change their communities - We need to recognize when and where certain communities are being excluded from decision making processes and assure that all people have the opportunity and capacity to participate in creating healthy communities

Structural Racism

- There is no "official definition" of this concept - But all definitions of this term share one idea: that racism is not simply the result of prejudices held by individuals, but also produced by laws, rules, and practices sanctioned and even implemented by various levels of government - Confronting racism, therefore, requires not only changing attitudes, but also dismantling policies and institutions that work against IPOC

Important

- This is continuum for a reason, it is not always clear cut where everyone stands - Individuals and organizations may be at different points on the continuum depending on the diversity dimension in reference

Whats a burden of disease?

- Toll on family - Geographical location - Cost

Health Inequity

- differences in health status between more and less socially and economically advantages groups - Cause by systematic differences in social conditions and processes that effectively determine health - avoidable, unjust, and therefore actionable

Adaptation

-Individuals develop and improve skills for interacting and communicating with people of other cultures - Individuals can empathize intellectually and emotionally with the experiences of others, or when they can interact in relaxed, authentic, and appropriate ways with people from different cultures - The key skill at this stage is perspective shifting, the ability to look at the world "through different eyes"

What is the importance of social justice in healthcare?

-Making sure that everyone has the same opportunity - Everyone has access to the care that they need despite the disparities

Ethnorelative Stages

Acceptance Adaptation Integration - In these stages, an individuals culture is experienced in context of other cultures - Able to recognize and appreciate differences between culture

Leading Health Disparities in the U.S.

Cardiovascular disease Cancer Diabetes HIV/AIDS Infant Mortality Asthma Mental Health Maternal Health

You/ The individual

Dieting behaviors, exercise, learning behaviors

Factors that determine health figure explained

Clinical care takes up 20% of our health Other 80%: - Social factors - Education - Money SES - Where you grew up Note that clinical care only accounts for ~20% percent of the total, yet we have often equated health care with health

Cultural Competence vs Cultural Humility

Cultural competence: - mastery/expert - Ideally, there is an endpoint to achieve - Rigid guidelines Cultural Humility: - Always a learner/student - No endpoint - Fluid and flexible - Personal, authentic

Cultural Competence vs Cultural Humility

Cultural competence: the ability of individuals to use academic, experimental, and interpersonal skills to increase their appreciation of cultural differences and similarities among, within, and between groups Cultural humility: process of reflection and lifelong inquiry, involves self-awareness of personal and cultural biases as well as awareness to significant cultural issues

Bennett's Developmental Stages of Intercultural Sensitivity

Denial Defense Minimization Acceptance Adaptation Integration

Lack of access to care (health disparity)

High out of pocket costs, geographic location

when people show up at the clinic with a health issue, there are always multiple underlying issues

Housing Income Family dynamics Transportation Mistrust Previous experience

Ethnorelative adaptation stage example

I "see" the world through different eyes and make intentional changes in my own behavior and values

Uninsured/Underinsured (health disparity)

Lacking insurance coverage or not having adequate insurance coverage

Ethnocentric denial stage example

My cultural experience is the only one that is real and valid. There is little to no thought of "other"

Why is Public Health Important?

Prevention! Public health professionals aim to prevent the problems from happening or recurring in society Accomplish through... - Educational programming - Needs assessment - Policy - Research

Secondary prevention

Prevents injury/ disease once exposure to risk factors occurs but still in early, "preclinical" stage

What would you say are necessary conditions for your health?

Sleep Water Nutritional food Community Shelter Insurance

"We all see the world through cultural glasses" - What does this quote mean? ( TedTalk)

Some cultures see some things from a different perspective just because of how they view themselves and others

Public health professionals

State health departments, healthy policy makers, health educators, curriculum advises, researchers

Primary prevention

Targets risk factors leading to injury/disease (safety belt laws or vaccinations)

Primordial Prevention

Targets social and economic policies affecting health

The "UN" populations: A Major Part of Health Disparities

Underserved Under deserved Underprivileged Underemployed Underclass Uninsured Underinsured Undocumented Undereducated Uninformed

redlining; affects peoples life expectancy

What is an example of structural inequity?

Mortality (health disparity)

death rate

What is equity rooted in?

justice and fairness

Defense Stage Quotes

- "Genetically, they don't have the capability to understand these things." - "This company was build on our own values, so our opinions are the most important" - "These are American schools, and they work really well for us, others should just learn to do it our way" - "immigrants are taking our jobs"

4 Pillars of Cultural Humility

- A lifelong process of critical self-reflection and self-critique - Redressing the power imbalances in the patient- provider dynamic - Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations - Advocation and maintaining institutional accountability that parallels the three principles above

Ways to create change

- A shift in thinking and acting this big requires multiple levels of response - Building public understanding of what creates health is essential - We must work to change the "narrative" so that people understand that health is created in the community by peoples working together to create just social and economic conditions - The next thing is to increase the expectations that these conditions can and will change - And public and political will is necessary because these are tough choices, and there will be competing forces - Accountability too is essential to follow up on the decisions that are made

Cultural Awareness

- Acknowledge differences - Doesn't seek broader context or understanding - Very limited behavior change

Environmental Barriers

- Air quality - Housing - Food safety

Acceptance

- An individual begins to recognize and value cultural differences without evaluating those differences as positive or negative - This stage moves an individual from ethnocentrism to ethnorelativism - First, comes a respect for cultural differences in behavior, and then a deeper respect for cultural differences in values - The acceptance stage may also manifest as greater curiosity about or interest in other cultures, and people may start to seek out cross-cultural relationships and social interactions that they might have avoided in the past - Bennett notes that acceptance does not require that one prefer, agree with, or endorse the behaviors or values of other cultures; it means that one recognizes and accepts the fact that different cultural worldviews exist

Minimization

- An individual in this stage acknowledges cultural differences, but trivializes them, believing that human similarities far outweigh any differences - Trivializing culture differences enables individuals to avoid recognizing their own cultural biases - Implying that cultural differences are unimportant or that they can be ignored or in claims that "deep down humans are alike" - Super difficult to move people form this stage

Why do we need Empathy?

- Empathy is,, communicating that incredibly healing message of "You're not alone" - Brene Brown - Empathy is: Seeing with the eyes of another, Listening with the ears of another, And feeling with the heart of another - Studies have shown... that those who spend time in self-reflection tend to have more empathy for others

Integration

- Engage in a process that involves exploring culture, examining how culture has impacted you both personally and professionally, and applying these insights in order to interact with others more effectively - While this is a process that involves a lot of self-reflection, no one can do it alone - In educational settings, integration is most likely to occur in schools that.. Serve culturally diverse families and students, Staffed with adults who demographics mirror the diversity of the student/family population, Teach from a multicultrual/multilingual point of view

Equality

- Equality is one of the central principles of democracy and is based on the belief that all people should have the same opportunities to be successful and have a productive, enjoyable life - Rooted in sameness - Everyone will be able to achieve based on their efforts and contributions

Equity

- Equity recognizes that everyone does not begin in the same place in society - Some people face adverse conditions and circumstances making it more challenging even with the same effort and desire, to achieve the same goals

Key Drivers of Health Disparities

- Institutional Barriers - Environmental Barriers - Social Barriers

What does Structural Racism look like?

- Redlining and Racialized residential segregation - Mass incarceration - Police brutality - Unequal medical care What do these examples share? - Harms that are historically grounded - Involve multiple institutions - Rely on ignorance in order to grow

Cultural Competency

- Represents action on the part of an individual or organization - Systems elements are aligned with respect to other cultures

Redlining

- To guide determinations of mortgage-worthiness. Home-owner loan corporation (HOLC) companies created maps of at least 239 U.S. cities - Using racial composition as part of its assessment, HOLD literally drew red lines around communities with large Black population, flagging them as hazardous investment areas whose residents would not receive housing loans - Redlining made mortgages less accessible, rendering prospective Black homeboys vulnerable to predatory terms, thereby increasing lender profits, reducing access to home ownership, and depriving these communities of an asset that is central to intergenerational wealth transfer

4 reasons why we need cultural and linguistic competence:

- To respond to current and projected demographic changes - To eliminate long-standing disparities in health status of people of diverse racial, ethnic and cultural backgrounds - To improve the quality of service and health outcomes - To meet legislatives, regulatory, and accreditation mandates

Ethnorelative worldviews

- Ways of seeking cultural difference, either by accepting its importance, by adapting perspective to take it into account, or by integrating - Positive connotation - The goal!

Tuskegee Experiment:

- syphilis treatment - African american men - Penicillin discovered although never given to patients of the treatment; experiment went on 30 years after treatment was discovered - Medical distrust

Cultural Competence

- the ability to understand and interact effectively with people from other cultures - Requires: Understanding of your own culture, A willingness to learn about the cultural practices and worldview of other, A positive attitude toward cultural differences and readiness to accept and respect those differences - Asking ourselves... "What adjustments both in the way I think and the way I behave do I need to make in order to effectively operate in a different cultural context?"

What are the three C's relating to culture? (TedTalk)

Conform: conscious effort Confront: wanting to make change Complaint: your individual behavior is the right behavior

Burden of disease (health disparity)

Considers health, social, political, economic and environmental factors to determine the cost that disease exerts upon an individual - Cost of treatment - Getting to where you need treatment - Support

In order to be effective, health education and prevention strategies must address each groups unique feature in a culturally and linguistically appropriate manner

Culture Experiences Language Age Gender Sexual orientation

Ethnocentric minimization stage example

Other cultures are trivialized or romanticized. One tends to deny difference (color blind) and only seek similarities

Necessary Conditions for Health

Peace Shelter Education Food Income Stable ecosystems Sustainable resources Social justice and equity

Healthcare professionals

Physical therapists, occupational therapists, technicians, physicians assistants, nurses, nurse practitioners

What makes something a health disparity?

The fact that these chronic diseases are adversely affecting certain groups of people over others.

Structural Inequities

Structures of systems of society - such as finance, housing, transportation, education, social opportunities - that are structured in such a way that they benefit one population unfairly (whether intended or not)

Covid-19 and Dimensions of Health Inequality

Testing, treatment, and health outcomes Lack of racial/ethnic testing data Ability to socially distance Housing and other social determinants Racist narratives and stigma Access to economic stimulus

Mass Incarceration

This extends beyond policing! Systematic racism is evident at every stage of the system - From policing - To prosecutorial decision - Pretrial release processes - Sentencing - Correctional discipline - Reentry

How is this demographic shift a call to action for health educators and professionals to become more culturally and linguistically competent?

- If people that your serving speak a different language it it important to make sure to communicate properly - Being aware of what's happening and be more empathetic

Equity

- everyone gets the treatment they NEED to succeed - Fairness or justice - Justice- the causes of the inequality was addressed

Health Equity

- attainment of the highest level of health possible for all people - Achieving health equity requires valuing everyone with a focus on ongoing social efforts to address - Avoidable inequalities - Historical and contemporary injustices - Elimination of health disparities

Equality

- everyone gets the same treatment; everyone is treated the same exact way, regardless of need or any other individual experience - "sameness"

Ethnocentric Stages

- Denial -Defense - minimization - In these stages, the individuals culture is central to reality in some way - Strong judgement towards other cultures

Why is this model important in the discussion of health disparities?

- Ethnocentric model: people keep a closed mind even though there are different world views and perspectives - The stages that people are in, may effect the policies they write and the way they treat other people - Why do they act the way they do? - Children aren't getting the proper education on how to start early to be more welcoming and understanding of other people who may be "different"

Denial

- First, most ethnocentric stage of Bennett's model - In this stage, an individual denies that cultural differences exist between groups - This belief may reflect either physical or social isolation from people or different cultural backgrounds -From this mindset we get: Cultural incapacity; lack of cultural awareness and skills

Real World Examples of Equity and Equality

- Gender equality: giving equal quantity of food to all family members at the table, irrespective of their nutritional requirement, dietary needs, allergies - Gender Equity: giving more nutritious and additional quantity of food to the pregnant and lactating women, based on their dietary requirements

Defense

- In the second stage of Bennett's model an individual acknowledges the existence of certain cultural differences, but because those differences are threatening to his or her own reality and sense of self, the individual constructs defenses against those differences - Occurs when people feel as though they are being victimized or attacked in discussions about bias, bigotry, or racism - In educational settings, the defense stage may manifest as protests/community opposition campaigns against racial integration, equitable school funding, or by diversifying populations - "Us against them" mentality

Why didn't the Fair Housing Act work?

- Just because laws are put in place doesn't mean there sustainable - Its really hard to change just because its a law

Cultural Humility

- Lifelong commitment to self-evaluation to readdress power imbalances - Develop and maintain respectful relationships based on mutual trust

What is structural Inequity?

- Systemic or structural elements of society that benefit one population unfairly - Finance - Housing - Transportation - Education - Social opportunities - Lower education: lack of qualified teachers, inadequate teaching materials, poor sanitation

The Power of interconnectivity

- The more we understand our interconnectedness, the more we move from "charity" or "services" for others to recognizing that the whole community is being held back by health inequities. - The health of everyone in the U.S. at different income levels is worse than the health of people of the same income in countries that have smaller inequities

Puerto Rican Sterilization Campaign

- Women told to get their tubes tied - 1 in 3 women in Puerto Rico were sterilized - Women's rights - Low economic status

Culture

- group membership such as racial, ethnic, linguistic, or geographical groups - Collection of beliefs, values, customs, ways of thinking, communicating, and behaving in a specific group - is learned, shared, and transmitted from one generation to the next - helps us organize + interpret life - Includes thought, styles of communication, ways of interacting, roles/relationships, values, practices and customs

Institutional Barriers

- laws/policies - Workplace mandates - Hospital settings

Cultural Humility

- lifelong process of self-reflection and self-critique whereby an individual not only is learning about other cultures, but starts to examine his/her/their own beliefs and identities - To be humble, means to demonstrate humility, which is often defined as "freedom of pride or arrogance"

Tertiary prevention

Rehabilitating persons with injury/disease to reduce complications (vocational rehab to retrain workers after alter)